What is wrong with us as a society that we seem so incapable of protecting those unable to look after themselves? Mary Raftery writes.
For the young, the elderly or those with disabilities, the State stands indicted again and again for its failure to care.
Six years ago, in the wake of the States of Fear documentaries on industrial schools, one of the most constructive and widespread responses was to ask what abuses are occurring today that future generations will condemn us for.
"I hope nothing like this is happening today," was the anxious but futile hope Taoiseach Bertie Ahern expressed in the Dáil at the time. Even at that stage the treatment of the elderly in nursing homes was being flagged as a scandal just waiting to be exposed.
This is exactly what last Monday's Prime Time Investigates has done. Its devastating examination of the Leas Cross nursing home in Swords is just the latest in a long line of damning reports on institutions caring for the elderly. As inadequate and secretive as the inspection mechanism for these homes clearly is, information has managed to trickle out of a number of gross abuses within the system.
During 1999, as the Taoiseach was expressing his nervous hopes in the Dáil, the State was aware of seriously sub-standard care of elderly residents at a nursing home in Co Waterford. Suppressed at the time, as are all such reports, the information has come to light recently through the tireless work on this issue by Fine Gael TD Fergus O'Dowd. He has been using the Freedom of Information Act to extract from our secretive State the information on what it has known about abuse of the elderly.
In the Waterford case, as in a number of others, it would appear that despite being hampered by inadequate legislation, the State authorities did manage to force the nursing home to improve its care. But the problem here is that all of this takes place in secret. Patients and their relatives are not informed either of sub-standard care, or of the efforts being made to remedy poor conditions and treatment. People are afraid to complain, lest they or their relative be victimised. In the absence of proper protection for whistleblowers, staff are equally fearful of being targeted if they speak out.
As in the case of the industrial schools, it is this pernicious secrecy which allows so much abuse to continue. This applies not just to nursing homes, but to children's homes, institutions for children and adults with intellectual disabilities, and of course psychiatric hospitals. And even where some information on inspections is available, the reports take on a depressing predictability in terms of endlessly highlighting the same inadequacies.
The Social Services Inspectorate complains tirelessly about the employment of large numbers of unqualified staff in children's homes.
There is no inspectorate of any kind for residential centres for people with intellectual disabilities, a world which remains almost completely closed to public scrutiny. A tiny glimpse of conditions in one of these institutions was afforded with the leaking of an evaluation report into the Kilcornan centre in Galway, run by the Brothers of Charity. This followed allegations of abuse and poor care, and was written over seven years ago.
It spoke of "the loss of opportunity, the lack of active support, the loss of freedom, the restrictions, the fear of assaults by other residents, the denial of rights, and the impoverishment of quality of life that everyday living in Kilcornan means". This report still has not been publicly released, and the Kilcornan centre remains open.
The publication of the recent report by Mr Justice Dermot Kinlen, the Inspector of Prisons, was delayed for almost a year, for legal reasons, we were told. When it emerged last April, it was scathing about the role of the State, condemning its "basic mantra" of "power, secrecy, control and security". It detailed the severe inadequacy of St Patrick's centre for young offenders and urgently recommended its closure.
Year after year, the Inspector of Mental Hospitals has exposed shocking conditions in psychiatric hospitals. Some of these reports were so disturbing that they were suppressed by governments over a number of years throughout the 1980s and 1990s.
I recently received a letter from a man whose young relative has been locked up in a psychiatric hospital in the south of the country. She has written repeatedly to him expressing a desire to be released.
So far, the hospital has refused him permission to even visit her. His letter to me was a plea for help, asking where can he turn for help against a system which has shut him out.
As with so many people who are now deeply concerned about the standard of care for their elderly relatives in nursing homes, the reality is that help is in short supply.
Secrecy, power and control are the predominant features of a system which purports to care for the vulnerable groups within society, but instead seeks to protect itself against any attempt to dilute that power.